Vol.:(0123456789) 1 3 Updates in Surgery https://doi.org/10.1007/s13304-018-0524-6 ORIGINAL ARTICLE Follow‑up after surgery for gastric cancer: how to do it Daniela Zanotti 1,2  · Gian Luca Baiocchi 1  · Arianna Coniglio 1  · Borzoueh Mohammadi 2  · Silvia Ministrini 1  · Muntzer Mughal 2  · Guido A. M. Tiberio 1  · Khaled Dawas 2 Received: 19 November 2017 / Accepted: 5 March 2018 © Italian Society of Surgery (SIC) 2018 Abstract There is no consensus on follow-up after gastric surgery for cancer, nor evidence that it improves outcomes. We investi- gated the impact of intensity of follow-up, comparing the regimens adopted by two centres, in Italy and in the UK. Patients who underwent surgery for gastric and junctional type-3 adenocarcinoma, between September 2009 and April 2013, at the Surgical Clinic, University of Brescia (Italy), and at the Department of Upper Gastrointestinal Surgery, University College London Hospital (UK), were identifed. Patients’ demographics, stage, recurrence rates, modality of detection and treatment were recorded. Overall survival and costs were compared between the two protocols. A total of 128 patients were included. Recurrence rates were similar (p = 0.349), with more than 70% diagnosed during regular follow-up appointments in both centres. At univariate and multivariate analysis, stage I and treatment of recurrence were associated with a better survival. Patients treated for recurrence at the Italian centre showed an almost signifcant better survival (p = 0.052). The intensive Italian surveillance protocol was associated with signifcant higher costs per year. Follow-up and early detection of recurrence did not afect survival in the analysed series, focused on periods in which chemotherapy was inefective towards recurrence. However, intensive follow-up allowed a greater number of patients to receive a treatment for recurrence; this might prove useful in the next few years, when more efective chemotherapy combinations are expected to become available. The costs could be reduced by adopting a less intensive surveillance programme. Keywords Follow-up · Gastric cancer · Gastric surgery · Surveillance Introduction Gastric cancer is the fourth most common cancer in the world, with the highest incidence rates in Japan and Eastern Asia. Despite a steady decline of the incidence over the last decades, the prognosis remains poor, with 5-years survival rates of 21.9% in Europe [1]. Recurrence usually occurs within 2 years of surgery [2–11]. Routine follow-up is practised worldwide, but its value after gastric cancer resection has not been established yet. At present, there are no randomised clinical trials (RCT) supporting follow-up. Several authors have investigated the survival beneft of early recurrence detection by inten- sive post-operative surveillance. Although some found that follow-up was successful in identifying asymptomatic recurrences, no improvement in overall survival (OS) was achieved [5, 10–16]. No standardised follow-up protocols are available [17–22]. Studies assessing the cost-efectiveness of follow- up in colorectal and breast cancers have been published [23, * Daniela Zanotti dani83k@gmail.com Gian Luca Baiocchi gianluca.baiocchi@unibs.it Arianna Coniglio arianna.coniglio@unibs.it Borzoueh Mohammadi borzoueh.mohammadi@uclh.nhs.uk Silvia Ministrini silvia.ministrini@hotmail.it Muntzer Mughal muntzer.mughal@uclh.nhs.uk Guido A. M. Tiberio guido.tiberio@unibs.it Khaled Dawas khaled.dawas@uclh.nhs.uk 1 Surgical Clinic, Department of Clinical and Experimental Sciences, Brescia University, P.le Spedali Civili, 1, 25123 Brescia, Italy 2 Gastrointestinal Services, University College Hospital, 250 Euston Road, London NW1 2PG, UK